Provider Demographics
NPI:1043403413
Name:DR. PETER G. PHILLIPS, PS
Entity Type:Organization
Organization Name:DR. PETER G. PHILLIPS, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-694-1118
Mailing Address - Street 1:8308 E MILL PLAIN BLVD
Mailing Address - Street 2:102
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-2007
Mailing Address - Country:US
Mailing Address - Phone:360-694-1118
Mailing Address - Fax:360-694-1979
Practice Address - Street 1:8308 E MILL PLAIN BLVD
Practice Address - Street 2:102
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-2007
Practice Address - Country:US
Practice Address - Phone:360-694-1118
Practice Address - Fax:360-694-1979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002231111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP00261964OtherRAIL ROAD MEDICARE
WAP00261964OtherRAIL ROAD MEDICARE
WAG8857051Medicare PIN